Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $89.13 / $177.83	Facility	26	$57.54	$89.13	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $316.23 / $1,949.84	Professional		$117.49	$316.23	$1,949.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $245.47 / $954.99	Professional	26	$57.54	$245.47	$954.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $117.49 / $512.86	Professional	TC	$54.95	$117.49	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $199.53 / $204.17	Facility	26	$194.98	$199.53	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $302.00 / $380.19	Professional		$281.84	$302.00	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $144.54 / $177.83	Professional	26	$134.90	$144.54	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $162.18 / $199.53	Professional	TC	$144.54	$162.18	$199.53
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $208.93 / $562.34	Professional		$125.89	$208.93	$562.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $102.33 / $354.81	Professional	26	$61.66	$102.33	$354.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $95.50 / $275.42	Professional	TC	$60.26	$95.50	$275.42
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $346.74	Facility	26	$199.53	$199.53	$346.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $245.47 / $870.96	Professional		$138.04	$245.47	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $851.14	Professional	26	$66.07	$85.11	$851.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $104.71 / $724.44	Professional	TC	$67.61	$104.71	$724.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $281.84 / $676.08	Professional		$245.47	$281.84	$676.08
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $134.90 / $223.87	Professional	26	$120.23	$134.90	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $144.54 / $446.68	Professional	TC	$125.89	$144.54	$446.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $204.17 / $204.17	Facility	26	$204.17	$204.17	$204.17
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $338.84	Professional		$295.12	$295.12	$338.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $141.25 / $162.18	Professional	26	$141.25	$141.25	$162.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $173.78	Professional	TC	$154.88	$154.88	$173.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $112.20 / $213.80	Professional		$60.26	$112.20	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $181.97 / $275.42	Professional		$131.83	$181.97	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $77.62 / $134.90	Professional	26	$66.07	$77.62	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $91.20 / $151.36	Professional	TC	$67.61	$91.20	$151.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $234.42 / $275.42	Professional		$186.21	$234.42	$275.42
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $131.83	Professional	26	$89.13	$112.20	$131.83
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $123.03 / $144.54	Professional	TC	$95.50	$123.03	$144.54